Neurology & Pain Management Coding Alert

Plus: Heads up on the timeline until ICD-10 implementation.

New and revised ICD-9 diagnosis codes will take effect October 1, with no grace period. Neurology coders will have a few new choices related to dementia and Lambert- Eaton syndrome, so take time now to get familiar with the expected changes.

Look for 'Unspecified' Dementia Options

The upcoming 2012 edition of ICD-9 will include two additional diagnoses for unspecified dementia. The new codes are:

• 294.20 -- Dementia, unspecified, without behavioral disturbance
• 294.21 -- Dementia, unspecified, with behavioral disturbance.

Codes 294.10 and 294.11 already describe dementia in conditions classified elsewhere (with and without behavioral disturbance). The new codes finally give you an accurate choice when the physician doesn't specify an associated condition. Until diagnoses 294.20 and 294.21 go into effect, is the alphabetic index for ICD-9-CM 2011 directs you to report diagnosis 294.8 (Other persistent mental disorders due to conditions classified elsewhere) for dementia NOS, says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACSPM, CHCO, owner of MJH Consulting in Denver, Co.

Note: According to the 2012 ICD-9 Tabular Index, the term "with behavioral disturbance" can include actions ranging from aggressive or combative behavior to something as simple as "wandering off."

Put Detailed Lambert-Eaton Choices Into Practice

Lambert-Eaton syndrome (sometimes referred to as Eaton-Lambert syndrome or myasthenic syndrome or LEMS) gains three new codes in ICD-9 for 2012. Currently, the only diagnosis related to the condition falls under 358.1 (Myasthenic syndromes in diseases classified elsewhere), with the explanatory note "Eaton-Lambert syndrome from stated cause classified elsewhere." Effective October 1, 2011, you'll have these new, more specific code choices:

• 358.30 -- Lambert-Eaton syndrome, unspecified
• 358.31 -- Lambert-Eaton syndrome in neoplastic disease
• 358.39 -- Lambert-Eaton syndrome in other diseases classified elsewhere.

"The uses of ICD go far beyond supporting of services provided and claims adjudication," Hammer says. "One of the primary original purposes is tracking morbidity and mortality." Based on the meeting transcripts where the new code was proposed, Hammer says the new codes were requested in order to differentiate the syndrome and particularly those patients who go on to develop the associated small cell lung cancer.

Definition: Lambert-Eaton syndrome is a disease characterized by the patient's immune system attacking the body's own tissues. Attacks occur at the junction between nerves and muscles, and interfere with the ability of nerve cells to send signals to muscle cells.

Migraine note: When you read through the list of revised codes, you'll see many migraine diagnoses listed (such as 346.01, Migraine with aura, with intractable migraine, so stated, without mention of status migrainosus, and 346.11, Migraine without aura, with intractable migraine, so stated, without mention of status migrainosus). The descriptors themselves remain the same, but the punctuation changes slightly. Updated descriptors add a comma following the "so stated" phrase in the fifth-digit "1" subclassification descriptor for each type of migraine noted. The change keeps the format consistent with the fifth-digit "3" subclassification descriptor.

Keep Track of the ICD-10 Timeline

With ICD-10 implementation set for October 2013, the ICD-9 Coordination and Maintenance Committee has implemented a partial freeze of ICD-9 and ICD-10 codes in the interim. The approved schedule will be:

• The last regular, annual updates to both ICD-9-CM and ICD-10 code sets will be made on October 1, 2011.
• On October 1, 2012, there will be only limited code updates to both the ICD-9-CM and ICD-10 code sets to capture new technologies and diagnoses.
• On October 1, 2013, there will be only limited code updates to ICD-10 code sets to capture new technologies and diagnoses.
• On October 1, 2014, regular updates to ICD-10 will begin.